Insulin and health systems in global low-resource settings

Published Date: 06th July 2026

Publication Authors: Ng. SM

Extract
In The Lancet Diabetes & Endocrinology, Jing Luo and colleagues present the HumAn-1 trial, an important contribution to the literature on type 1 diabetes in low-income and middle-income countries (LMICs), particularly for children and young people who have historically been under-represented in clinical trials.¹ By comparing insulin glargine with isophane insulin or premixed 70/30 (ie, usual care) in participants aged 7–25 years in a multicentre randomised design using continuous glucose monitoring (CGM)-derived metrics, the study provides context-specific evidence that moves beyond extrapolation from high-income settings. Importantly, the study shows that although insulin analogues are widely assumed to be superior, this advantage is not consistently reflected in key outcomes including time in normal glucose range (time in target range), time in very low glucose range (also referred to as time in serious hypoglycaemia or level 2 hypoglycaemia), and overall glycaemic control, particularly at 6 months. This finding challenges prevailing assumptions derived from earlier meta-analyses and trials conducted predominantly in resource-rich environments, in which modest HbA1c reductions and lower hypoglycaemia rates have been reported.^2,3

Ng, SM. (2026). Insulin and health systems in global low-resource settings. The Lancet Diabetes & Endocrinology. Pub Online 06 Jul, [Online]. Available at: https://doi.org/10.1016/S2213-8587(26)00128-2 [Accessed 14 July 2026]